COLUMBUS, Ohio -- Very young children treated with
normally prescribed
amounts of the psychoactive medication lithium will likely
experience
adverse side effects during the first weeks of treatment.

Researchers at Ohio State University reviewed the medical
records
of children under age 7 who began inpatient lithium therapy for
severe aggressive behavior or bipolar disorder (also called
manic-depressive
disorder) over a five-year period. They found that 60 percent
of children experienced one or more side effects during the first
two weeks of lithium therapy.

Further, they found that among these children, one-third
suffered
serious impairments of the central nervous system (CNS), such
as slurred speech, confusion and loss of coordination.

"People must be very careful when giving lithium to very
young children," said Elizabeth Weller, a professor of
psychiatry
and pediatrics at Ohio State and a co-author of the study.
"There
are a lot of side effects in children that just can't be

ignored."

Children with bipolar disorder, conduct disorder and extreme
aggressive behavior have been shown to improve with lithium
treatment,
Weller said. Bipolar disorder is characterized by alternating
episodes of mania and depression. Conduct disorder is
characterized
by violent, disobedient behavior, such as lying, stealing and
being cruel to animals.

"We always discourage lithium treatment; it's nearly always
a last resort," Weller said. "However, if the choice
is between being able to keep children in preschool or
kindergarten
or having them expelled because of aggression, then it's
appropriate
to try them on it." Untreated conduct disorders and
aggressive
behavior can lead to chronic antisocial behavior and substance
abuse in adulthood, she added.

Weller conducted this research with Owen R. Hagino, an
instructor
in psychiatry and pediatrics at Brown University, and four
colleagues
from Ohio State: Ronald A. Weller, a professor of
psychiatry;
Douglas Washing, a medical student; Mary A. Fristad, an associate
professor of psychiatry; and Stella B. Kontras, professor
emeritus
of psychiatry and pediatrics. The group's work was published
in the Journal of the American Academy of Child and Adolescent
Psychiatry.

For their study, the researchers reviewed the medical records
of 20 children under 7 who were treated with lithium in the
children's
inpatient psychiatric unit at Ohio State University Medical
Center.
Twelve children received lithium to reduce aggression; the other
eight received it for mood stabilization. For each child, the
researchers noted the initial lithium dose, subsequent dose
adjustments,
blood lithium levels at different points in time and frequency
and severity of side effects. If during the course of treatment
a child experienced serious CNS side effects, lithium therapy
was suspended.

The results:

CNS impairments (tremor, drowsiness, confusion, loss of
coordination)
were the most common side effects of lithium therapy, experienced
by half the children in the study. Nausea, vomiting, diarrhea
and other gastrointestinal side effects were the next most
common,
experienced by 25 percent of the children.

Among the 12 children who suffered lithium side effects, nine
experienced them during the first week of treatment. No children
experienced adverse effects after the eleventh day of treatment.

The lithium doses of those children who suffered side effects
ranged widely, from 25.6 to 52.1 mg/kg per day. In fact, the
lithium doses of those children who suffered side effects in the
first week of treatment were not significantly higher than those
of children who suffered no side effects. However, average blood
lithium levels were significantly higher among those children
who suffered side effects than among those who did not. "In
general, the appearance of side effects was associated with
higher
lithium levels and larger doses," Weller said.

Those children who suffered serious CNS side effects were
on significantly higher doses and had higher blood lithium levels
than those kids who suffered such "nuisance" side
effects
as tremors, nausea and excessive urine production.

Those children who began lithium therapy while ill with
another
medical condition had more serious side effects than those
children
who began therapy while healthy. In addition, those children
being treated for bipolar disorder tended to have more serious
lithium side effects than those being treated for other
psychiatric
conditions.

Weller says she hopes these findings will encourage physicians
to proceed with extreme caution when prescribing lithium for very
young children. Specifically, she recommends that physicians
start these children on lithium doses of no more than 30 mg/kg
per day, measure blood lithium level every other day for the
first
two weeks of treatment and use extra care when prescribing
lithium
for a child who is ill.

In addition, Weller says she hopes these findings will encourage
parents to be conscientious medical consumers.

"Parents should be very careful if someone wants to put
their child on lithium," she said. "They should be
sure the person prescribing it has a lot of experience with it.
Regional referral centers generally have more expertise with
psychotropic medications. It's always safer to go to places that
have experience."